| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,400.00 | $1,417.93 | $1,417.93 | |
CareSource
| Facility | $1,614.96 | $1,846.22 | $2,011.49 | |
Cigna
| Facility | $1,733.58 | $1,733.58 | $1,733.58 | |
Cigna
| Facility | 62 | $1,070.69 | $1,070.69 | $1,070.69 |